Purpose: To develop a clinically relevant porcine model for the study of hepatic metabolism of dr... more Purpose: To develop a clinically relevant porcine model for the study of hepatic metabolism of drugs by means of hepatic vein catheterization. Materials and methods: review of literature and elaboration of a hypothesis, design of an experimental method. Results: recent clinical studies were conducted by withdrawing cirrhotic patients' blood from right hepatic vein during hepatic vein pressure gradient measurements. Basing on our personal clinical experience and evaluation of research needs, an experimental model is proposed. Conclusions: contemporary measurement of peripheral and hepatic concentration of drugs by peripheral vein and hepatic vein catheterization can be used to create a reliable and reproducible porcine model to study liver metabolism of drugs in vivo.
Trends in Anaesthesia and Critical Care, Apr 1, 2013
Donation after cardiac death is defined as organ donation once death is declared after irreversib... more Donation after cardiac death is defined as organ donation once death is declared after irreversible cessation of circulatory and respiratory functions. The aim of this subjective review is to evaluate the outcome of grafts and recipients in consideration of the length of ischaemia and individuating those who can be considered suitable donors after cardiac arrest. Our main conclusion is that graft and patient survival are comparable either if the organs come from non-heart-beating-donors (NHBD) or heart beating donors (HBD) but complications were reported more frequently in NHBD than in HBD. Warm ischaemia time reduction and close selection of donors are keys to successful NHBD transplantation.
Background: The aim of this study was to test if different recruitment maneuver (RM) patterns, th... more Background: The aim of this study was to test if different recruitment maneuver (RM) patterns, that achieve the same maximum pressure for the same length of time in humans, have a similar efficacy on alveolar recruitment, intrathoracic vascular pressures and flows, and on cardiac function and ventricular filling. Methods: Forty patients were randomly allocated to undergo different RM patterns: sustained inflation (SI) or pressure controlled ventilation (PCV). The RM methods tested are as follows: SI was achieved by raising peak inspiratory pressure to 45 cmH(2)O and sustaining it for 40 seconds. The PCV was set to obtain a 45 cmH(2)O peak inspiratory pressure for 2 minutes, I:E 1:2, PEEP 16 RR 8/min. During the study period, patients were mechanically ventilated to obtain a volume of 6 mL/kg, FiO(2) 0.7, PEEP 14, RR 14, Pplateau < or =30 cmH(2)O according to the ARDSnet trial. All patients were sedated and paralyzed during the study period. All patients were given i.v. norepinephrine. Heart rate, pulse oxymetry, blood pressure, pulmonary artery catheter data (C.I., PVRI, MPAP, PAOP, SvO(2), CVP), and arterial and right heart side venous blood gas analysis data (ph, PaO(2), PaCO(2), SatO(2), HCO(3)(-), SvO(2)) were recorded before and immediately after the lung recruitment maneuver. The static compliance of the respiratory system (CRS) was recorded. Echocardiographic spot evaluations before and after RM were obtained in all cases. Results: Central venous pressure increased during RM. Mean pulmonary artery pressure, pulmonary capillary wedge pressure and pulmonary vascular resistance index were reduced during PCV RM compared to SI RM (P<0.05). The right ventricle stroke work index decreased to a major extent during PCV RM (P<0.05). The P/F ratio was significantly increased after PCV RM compared to SI RM (P<0.05). PaCO(2) levels were similar in the two groups. Compared to baseline, the Qs/Qt decreased significantly after the PCV recruitment maneuver. Ventricular end-diastolic and end-systolic areas decreased during both RM protocols, but they were decreased to a greater extent after SI RM than after PCV RM (P<0.05). The eccentricity index increased from baseline after the SI RM (P<0.05). Conclusion: Given its comparable, or even superior, performance over the SI RM, we favor the PCV technique over the time-honored SI maneuver.
Journal of Anesthesia, Analgesia and Critical Care, Aug 20, 2022
Background: Krebs von den Lungen 6 (KL-6) is a high-molecular-weight mucin-like glycoprotein, whi... more Background: Krebs von den Lungen 6 (KL-6) is a high-molecular-weight mucin-like glycoprotein, which is also known as MUC1. KL-6 is mainly produced by type 2 pneumocytes and bronchial epithelial cells, and, therefore, elevated circulating KL-6 levels may denote disorders of the alveolar epithelial lining. The objective of this study is to verify if KL-6 serum level might support ICU physicians in predicting mortality, risk stratifying and triaging severe COVID-19 patients. Methods: A retrospective cohort study, including all the COVID-19 patients who measured KL-6 serum values at least once during their ICU stay, was performed. The study sample, 122 patients, was divided in two groups, according to the median KL-6 value at ICU admission (median log-transformed KL-6 value: 6.73 U/ml; group A: KL-6 lower than the median and group B: KL-6 higher than the median). Results: One-hundred twenty-two ICU patients were included in this study. Mortality was higher in group B than in group A (80 versus 46%; p < 0.001); both linear and logistic multivariate analyses showed ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (P/F) significantly and inversely related to KL-6 values. Conclusion: At ICU admission, KL-6 serum level was significantly higher in the most hypoxic COVID-19 patients and independently associated with ICU mortality.
Journal of Anesthesia, Analgesia and Critical Care, Feb 15, 2022
Background: During the COVID-19 pandemia, non-invasive mechanical ventilation (NIV) has been larg... more Background: During the COVID-19 pandemia, non-invasive mechanical ventilation (NIV) has been largely applied. Few data are available about predictors of NIV failure in critical COVID-19 patients admitted to ICU. The aim of this study is to analyze clinical and laboratory features able to predict non-invasive ventilation success in avoiding endotracheal intubation. Methods: A retrospective observational study was performed in our COVID-19 ICU during a 6-month period. Demographic, clinical, laboratory, imaging, and outcome data were extracted from electronic and paper medical records and anonymously collected. Results: Eighty-two severe COVID-19 patients were supported by NIV at ICU admission. The median PaO 2 /FiO 2 ratio was 125 [98.5-177.7]. NIV failed in 44 cases (53%). Patients who experienced NIV failure had a higher Charlson Comorbidity Index (median value 4) compared to those who were dismissed without endotracheal intubation (median 2, p < 0.0001). At Cox regression analysis, the Charlson Comorbidity Index represented a predictive factor related to NIV failure. PaO 2 /FiO 2 , CPK, INR, and AT III at ICU admission showed a significant relationship with the outcome, when single variables were adjusted for the Charlson Comorbidity Index. Conclusion: The Charlson Comorbidity Index may be helpful to stratify patients' risk of NIV failure in a severe COVID-19 population; even if this study, retrospective design does not allow definitive conclusions.
With respect to the once versus twice daily injections of low molecular weight heparin, we apprec... more With respect to the once versus twice daily injections of low molecular weight heparin, we appreciate the comment on the EFFORT randomised trial, which did actually not compare two different protocols of low molecular weight heparin. This study showed that the percentage of patients who achieved target antiXa levels was higher in the fondaparinux group, a selective inhibitor of factor Xa. However, there were no significant differences in the rates of venous thromboembolism or bleeding. We congratulate Dr Steib for their excellent study, published after our article was written. Their study indicates that 6000 IU 24 1 may be better than 4000 IU once or twice daily and provides an interesting hypothesis explaining their results.
Xenon is a colorless and odorless noble gas, licensed for human use as an anesthetic gas as well ... more Xenon is a colorless and odorless noble gas, licensed for human use as an anesthetic gas as well as a radiological marker. the Mac of this gas is about 63% but xenon anesthesia is associated with fast recovery of cognitive function and cardiovascular stability. Nevertheless, postoperative nausea and vomiting (PoNV) incidence for xenon anesthesia is very high. it has been reported that Xenon has cytoprotective effects that may have therapeutic values in both cNs protection, and in organ graft preservation. currently, there are few studies about the effect of xenon on ischemia reperfusion injury of transplantable organs and insufficient clinical data upon its effect on intracranial and cerebral perfusion pressure. We shortly review the pros and cons of xenon as an anesthetic agent.
Patients in septic shock with low IgG and IgM serum concentrations have higher mortality rates co... more Patients in septic shock with low IgG and IgM serum concentrations have higher mortality rates compared to those with normal immunoglobulin levels and, therefore, there is a rational explanation to administer intravenous IgM-enriched immunoglobulins to septic patients in ICU. Aim of this study is to evaluate the effectiveness of intravenous IgMenriched immunoglobulins in decreasing several sepsis biomarker concentrations. 26 sepsis patients were enrolled in this observational cohort study and Nitric Oxide, Endocan, Pentraxin and presepsin serum levels were measured during their first 3 days of ICU stay. The use of intravenous IgM-enriched immunoglobulins did not influence the temporal evolution of SOFA, Nitric Oxide, Endocan, Pentraxin and Presepsin in the first 3 days of ICU stay in a statistically significant manner, even if Presepsin decreased of 25% from day 1 to day 2 in the Pentaglobin group. It seems possible that Pentaglobin infusion reduces the Presepsin level in a more effective way if it were administered to a younger population (p 0.012). In conclusion, age modifies the response of Presepsin to Pentaglobin and is a critical variable when investigating the effect of intravenous IgM-enriched immunoglobulins on sepsis.
Monitoring and measuring magnesium (Mg) values are essential to prevent the development of numero... more Monitoring and measuring magnesium (Mg) values are essential to prevent the development of numerous complications in perioperative medicine and critically ill patients. Although previous studies suggest that measuring free ionized magnesium (iMg) is more useful for estimating Mg status, clinicians currently rely on measurement of total serum magnesium to determine if supplemental magnesium is needed. In this review, we analyzed the recent literature to decide whether it is better to measure ionized serum Mg or total serum Mg when assessing magnesium status, whether iMg predicts clinical outcome, and what are the difficulties in measuring serum iMg levels in intensive care patients and perioperative medicine.
Conclusion(s): Xenon preconditioning attenuates cognitive decline following surgery and this bene... more Conclusion(s): Xenon preconditioning attenuates cognitive decline following surgery and this benefit may be due to the upregulation of Hsp72. Acknowledgements: Lei Zhuang for helping to develop the WBs. References:
Trends in Anaesthesia and Critical Care, Sep 1, 2016
From the need to contain the health expenditure and reduce the abuse of diagnostic tests and proc... more From the need to contain the health expenditure and reduce the abuse of diagnostic tests and procedures which do not bring substantial benefits to patients, arises the "Choosing wisely" campaign. Every scientific society that has joined the campaign has developed a "top five list" of five avoidable diagnostic / therapeutic procedures, chosen by experts based on evidenced based medicine. The "top five list" provided by the American Society of Anesthesiologist (ASA) pertains the preoperative and intraoperative practices. In this review, we examine the possibility of applying the top-five list of ASA in obstetric anesthesia, highlighting the effects of "a wise choice" in this field.
International Journal of Pharmaceutics, Aug 1, 2016
Highlights Investigation of metabolism of remifentanil Evaluation of esterases in remifentani... more Highlights Investigation of metabolism of remifentanil Evaluation of esterases in remifentanil enzymatic kinetics of degradation Observation of temperature effects on pharmacokinetics, which is relevant in clinical practice Liver esterases and temperature
Presepsin is the soluble fragment of CD14, a multifunctional glycoprotein expressed on the surfac... more Presepsin is the soluble fragment of CD14, a multifunctional glycoprotein expressed on the surface of innate immune cells. In healthy individuals, presepsin is present in very low concentrations with reference values ranging from 60 to 382 pg/ml. Several studies have shown that presepsin is a valuable biomarker for sepsis diagnosis in adults. Only lately, presepsin has been evaluated for prediction and early detection of neonatal sepsis and septic shock. Elevated plasma presepsin concentration has also been reported in patients undergoing cardiac and non- cardiac surgery and it has further been evaluated as a potential independent predictor of perioperative cardiovascular complications and mortality. Combined cardiac and inflammatory biomarker evaluation may offer additive predictive information, but further investigations in large populations are required to determine presepsin diagnostic and prognostic value, in order to personalise therapy and reduce surgical patients' morbidity and mortality.
Dislocation of the heart is a rare complication of thoracic blunt trauma. A high index of suspici... more Dislocation of the heart is a rare complication of thoracic blunt trauma. A high index of suspicion of pericardium rupture is necessary to formulate an early diagnosis to reduce morbidity and mortality. A 23-year-old man suffered a blunt thoracoabdominal trauma and was admitted 3 days later to a university hospital ICU for right heart luxation due to right pericardial tear. Mechanical ventilation delayed radiological findings. Surgery by repositioning the heart and repairing the pericardial tear allowed restoration of hemodynamic equilibrium.
Journal of Pharmaceutical and Biomedical Analysis, Aug 1, 2022
COVID-19 infection evokes various systemic alterations that push patients not only towards severe... more COVID-19 infection evokes various systemic alterations that push patients not only towards severe acute respiratory syndrome but causes an important metabolic dysregulation with following multi-organ alteration and potentially poor outcome. To discover novel potential biomarkers able to predict disease’s severity and patient’s outcome, in this study we applied untargeted lipidomics, by a reversed phase ultra-high performance liquid chromatography-trapped ion mobility mass spectrometry platform (RP-UHPLC-TIMS-MS), on blood samples collected at hospital admission in an Italian cohort of COVID-19 patients (45 mild, 54 severe, 21 controls). In a subset of patients, we also collected a second blood sample in correspondence of clinical phenotype modification (longitudinal population). Plasma lipid profiles revealed several lipids significantly modified in COVID-19 patients with respect to controls and able to discern between mild and severe clinical phenotype. Severe patients were characterized by a progressive decrease in the levels of LPCs, LPC-Os, PC-Os, and, on the contrary, an increase in overall TGs, PEs, and Ceramides. A machine learning model was built by using both the entire dataset and with a restricted lipid panel dataset, delivering comparable results in predicting severity (AUC= 0.777, CI: 0.639–0.904) and outcome (AUC= 0.789, CI: 0.658–0.910). Finally, re-building the model with 25 longitudinal (t1) samples, this resulted in 21 patients correctly classified. In conclusion, this study highlights specific lipid profiles that could be used monitor the possible trajectory of COVID-19 patients at hospital admission, which could be used in targeted approaches.
Introduction: Levosimendan is a positive inotropic molecule that does not reduce splanchnic circu... more Introduction: Levosimendan is a positive inotropic molecule that does not reduce splanchnic circulation and has anti ischemic properties by opening mito KATP channels. Cirrhosis is a chronic and diffuse process characterized by fibrosis and the conversion of typical liver architecture into structurally abnormal nodules. In the late stages of the disease, cirrhosis is responsible for organ failure and complications such as cirrhotic cardiomyopathy and hepatic encephalopathy. Material and methods: We examined the effect of levosimendan in rat models of liver cirrhosis. Male Wistar rats were divided into four groups: Group A: cirrhotic rats 14 days after bile duct ligation (BDL); Group B: control (intact rats); Group A1: BDL and levosimendan (liver cirrhosis induced by bile duct ligation plus intraperitoneal administration of levosimendan); Group B1: control and levosimendan (intact animals with normal liver function treated with an intraperitoneal injection of levosimendan). Each grou...
Purpose: To develop a clinically relevant porcine model for the study of hepatic metabolism of dr... more Purpose: To develop a clinically relevant porcine model for the study of hepatic metabolism of drugs by means of hepatic vein catheterization. Materials and methods: review of literature and elaboration of a hypothesis, design of an experimental method. Results: recent clinical studies were conducted by withdrawing cirrhotic patients' blood from right hepatic vein during hepatic vein pressure gradient measurements. Basing on our personal clinical experience and evaluation of research needs, an experimental model is proposed. Conclusions: contemporary measurement of peripheral and hepatic concentration of drugs by peripheral vein and hepatic vein catheterization can be used to create a reliable and reproducible porcine model to study liver metabolism of drugs in vivo.
Trends in Anaesthesia and Critical Care, Apr 1, 2013
Donation after cardiac death is defined as organ donation once death is declared after irreversib... more Donation after cardiac death is defined as organ donation once death is declared after irreversible cessation of circulatory and respiratory functions. The aim of this subjective review is to evaluate the outcome of grafts and recipients in consideration of the length of ischaemia and individuating those who can be considered suitable donors after cardiac arrest. Our main conclusion is that graft and patient survival are comparable either if the organs come from non-heart-beating-donors (NHBD) or heart beating donors (HBD) but complications were reported more frequently in NHBD than in HBD. Warm ischaemia time reduction and close selection of donors are keys to successful NHBD transplantation.
Background: The aim of this study was to test if different recruitment maneuver (RM) patterns, th... more Background: The aim of this study was to test if different recruitment maneuver (RM) patterns, that achieve the same maximum pressure for the same length of time in humans, have a similar efficacy on alveolar recruitment, intrathoracic vascular pressures and flows, and on cardiac function and ventricular filling. Methods: Forty patients were randomly allocated to undergo different RM patterns: sustained inflation (SI) or pressure controlled ventilation (PCV). The RM methods tested are as follows: SI was achieved by raising peak inspiratory pressure to 45 cmH(2)O and sustaining it for 40 seconds. The PCV was set to obtain a 45 cmH(2)O peak inspiratory pressure for 2 minutes, I:E 1:2, PEEP 16 RR 8/min. During the study period, patients were mechanically ventilated to obtain a volume of 6 mL/kg, FiO(2) 0.7, PEEP 14, RR 14, Pplateau < or =30 cmH(2)O according to the ARDSnet trial. All patients were sedated and paralyzed during the study period. All patients were given i.v. norepinephrine. Heart rate, pulse oxymetry, blood pressure, pulmonary artery catheter data (C.I., PVRI, MPAP, PAOP, SvO(2), CVP), and arterial and right heart side venous blood gas analysis data (ph, PaO(2), PaCO(2), SatO(2), HCO(3)(-), SvO(2)) were recorded before and immediately after the lung recruitment maneuver. The static compliance of the respiratory system (CRS) was recorded. Echocardiographic spot evaluations before and after RM were obtained in all cases. Results: Central venous pressure increased during RM. Mean pulmonary artery pressure, pulmonary capillary wedge pressure and pulmonary vascular resistance index were reduced during PCV RM compared to SI RM (P<0.05). The right ventricle stroke work index decreased to a major extent during PCV RM (P<0.05). The P/F ratio was significantly increased after PCV RM compared to SI RM (P<0.05). PaCO(2) levels were similar in the two groups. Compared to baseline, the Qs/Qt decreased significantly after the PCV recruitment maneuver. Ventricular end-diastolic and end-systolic areas decreased during both RM protocols, but they were decreased to a greater extent after SI RM than after PCV RM (P<0.05). The eccentricity index increased from baseline after the SI RM (P<0.05). Conclusion: Given its comparable, or even superior, performance over the SI RM, we favor the PCV technique over the time-honored SI maneuver.
Journal of Anesthesia, Analgesia and Critical Care, Aug 20, 2022
Background: Krebs von den Lungen 6 (KL-6) is a high-molecular-weight mucin-like glycoprotein, whi... more Background: Krebs von den Lungen 6 (KL-6) is a high-molecular-weight mucin-like glycoprotein, which is also known as MUC1. KL-6 is mainly produced by type 2 pneumocytes and bronchial epithelial cells, and, therefore, elevated circulating KL-6 levels may denote disorders of the alveolar epithelial lining. The objective of this study is to verify if KL-6 serum level might support ICU physicians in predicting mortality, risk stratifying and triaging severe COVID-19 patients. Methods: A retrospective cohort study, including all the COVID-19 patients who measured KL-6 serum values at least once during their ICU stay, was performed. The study sample, 122 patients, was divided in two groups, according to the median KL-6 value at ICU admission (median log-transformed KL-6 value: 6.73 U/ml; group A: KL-6 lower than the median and group B: KL-6 higher than the median). Results: One-hundred twenty-two ICU patients were included in this study. Mortality was higher in group B than in group A (80 versus 46%; p < 0.001); both linear and logistic multivariate analyses showed ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (P/F) significantly and inversely related to KL-6 values. Conclusion: At ICU admission, KL-6 serum level was significantly higher in the most hypoxic COVID-19 patients and independently associated with ICU mortality.
Journal of Anesthesia, Analgesia and Critical Care, Feb 15, 2022
Background: During the COVID-19 pandemia, non-invasive mechanical ventilation (NIV) has been larg... more Background: During the COVID-19 pandemia, non-invasive mechanical ventilation (NIV) has been largely applied. Few data are available about predictors of NIV failure in critical COVID-19 patients admitted to ICU. The aim of this study is to analyze clinical and laboratory features able to predict non-invasive ventilation success in avoiding endotracheal intubation. Methods: A retrospective observational study was performed in our COVID-19 ICU during a 6-month period. Demographic, clinical, laboratory, imaging, and outcome data were extracted from electronic and paper medical records and anonymously collected. Results: Eighty-two severe COVID-19 patients were supported by NIV at ICU admission. The median PaO 2 /FiO 2 ratio was 125 [98.5-177.7]. NIV failed in 44 cases (53%). Patients who experienced NIV failure had a higher Charlson Comorbidity Index (median value 4) compared to those who were dismissed without endotracheal intubation (median 2, p < 0.0001). At Cox regression analysis, the Charlson Comorbidity Index represented a predictive factor related to NIV failure. PaO 2 /FiO 2 , CPK, INR, and AT III at ICU admission showed a significant relationship with the outcome, when single variables were adjusted for the Charlson Comorbidity Index. Conclusion: The Charlson Comorbidity Index may be helpful to stratify patients' risk of NIV failure in a severe COVID-19 population; even if this study, retrospective design does not allow definitive conclusions.
With respect to the once versus twice daily injections of low molecular weight heparin, we apprec... more With respect to the once versus twice daily injections of low molecular weight heparin, we appreciate the comment on the EFFORT randomised trial, which did actually not compare two different protocols of low molecular weight heparin. This study showed that the percentage of patients who achieved target antiXa levels was higher in the fondaparinux group, a selective inhibitor of factor Xa. However, there were no significant differences in the rates of venous thromboembolism or bleeding. We congratulate Dr Steib for their excellent study, published after our article was written. Their study indicates that 6000 IU 24 1 may be better than 4000 IU once or twice daily and provides an interesting hypothesis explaining their results.
Xenon is a colorless and odorless noble gas, licensed for human use as an anesthetic gas as well ... more Xenon is a colorless and odorless noble gas, licensed for human use as an anesthetic gas as well as a radiological marker. the Mac of this gas is about 63% but xenon anesthesia is associated with fast recovery of cognitive function and cardiovascular stability. Nevertheless, postoperative nausea and vomiting (PoNV) incidence for xenon anesthesia is very high. it has been reported that Xenon has cytoprotective effects that may have therapeutic values in both cNs protection, and in organ graft preservation. currently, there are few studies about the effect of xenon on ischemia reperfusion injury of transplantable organs and insufficient clinical data upon its effect on intracranial and cerebral perfusion pressure. We shortly review the pros and cons of xenon as an anesthetic agent.
Patients in septic shock with low IgG and IgM serum concentrations have higher mortality rates co... more Patients in septic shock with low IgG and IgM serum concentrations have higher mortality rates compared to those with normal immunoglobulin levels and, therefore, there is a rational explanation to administer intravenous IgM-enriched immunoglobulins to septic patients in ICU. Aim of this study is to evaluate the effectiveness of intravenous IgMenriched immunoglobulins in decreasing several sepsis biomarker concentrations. 26 sepsis patients were enrolled in this observational cohort study and Nitric Oxide, Endocan, Pentraxin and presepsin serum levels were measured during their first 3 days of ICU stay. The use of intravenous IgM-enriched immunoglobulins did not influence the temporal evolution of SOFA, Nitric Oxide, Endocan, Pentraxin and Presepsin in the first 3 days of ICU stay in a statistically significant manner, even if Presepsin decreased of 25% from day 1 to day 2 in the Pentaglobin group. It seems possible that Pentaglobin infusion reduces the Presepsin level in a more effective way if it were administered to a younger population (p 0.012). In conclusion, age modifies the response of Presepsin to Pentaglobin and is a critical variable when investigating the effect of intravenous IgM-enriched immunoglobulins on sepsis.
Monitoring and measuring magnesium (Mg) values are essential to prevent the development of numero... more Monitoring and measuring magnesium (Mg) values are essential to prevent the development of numerous complications in perioperative medicine and critically ill patients. Although previous studies suggest that measuring free ionized magnesium (iMg) is more useful for estimating Mg status, clinicians currently rely on measurement of total serum magnesium to determine if supplemental magnesium is needed. In this review, we analyzed the recent literature to decide whether it is better to measure ionized serum Mg or total serum Mg when assessing magnesium status, whether iMg predicts clinical outcome, and what are the difficulties in measuring serum iMg levels in intensive care patients and perioperative medicine.
Conclusion(s): Xenon preconditioning attenuates cognitive decline following surgery and this bene... more Conclusion(s): Xenon preconditioning attenuates cognitive decline following surgery and this benefit may be due to the upregulation of Hsp72. Acknowledgements: Lei Zhuang for helping to develop the WBs. References:
Trends in Anaesthesia and Critical Care, Sep 1, 2016
From the need to contain the health expenditure and reduce the abuse of diagnostic tests and proc... more From the need to contain the health expenditure and reduce the abuse of diagnostic tests and procedures which do not bring substantial benefits to patients, arises the "Choosing wisely" campaign. Every scientific society that has joined the campaign has developed a "top five list" of five avoidable diagnostic / therapeutic procedures, chosen by experts based on evidenced based medicine. The "top five list" provided by the American Society of Anesthesiologist (ASA) pertains the preoperative and intraoperative practices. In this review, we examine the possibility of applying the top-five list of ASA in obstetric anesthesia, highlighting the effects of "a wise choice" in this field.
International Journal of Pharmaceutics, Aug 1, 2016
Highlights Investigation of metabolism of remifentanil Evaluation of esterases in remifentani... more Highlights Investigation of metabolism of remifentanil Evaluation of esterases in remifentanil enzymatic kinetics of degradation Observation of temperature effects on pharmacokinetics, which is relevant in clinical practice Liver esterases and temperature
Presepsin is the soluble fragment of CD14, a multifunctional glycoprotein expressed on the surfac... more Presepsin is the soluble fragment of CD14, a multifunctional glycoprotein expressed on the surface of innate immune cells. In healthy individuals, presepsin is present in very low concentrations with reference values ranging from 60 to 382 pg/ml. Several studies have shown that presepsin is a valuable biomarker for sepsis diagnosis in adults. Only lately, presepsin has been evaluated for prediction and early detection of neonatal sepsis and septic shock. Elevated plasma presepsin concentration has also been reported in patients undergoing cardiac and non- cardiac surgery and it has further been evaluated as a potential independent predictor of perioperative cardiovascular complications and mortality. Combined cardiac and inflammatory biomarker evaluation may offer additive predictive information, but further investigations in large populations are required to determine presepsin diagnostic and prognostic value, in order to personalise therapy and reduce surgical patients' morbidity and mortality.
Dislocation of the heart is a rare complication of thoracic blunt trauma. A high index of suspici... more Dislocation of the heart is a rare complication of thoracic blunt trauma. A high index of suspicion of pericardium rupture is necessary to formulate an early diagnosis to reduce morbidity and mortality. A 23-year-old man suffered a blunt thoracoabdominal trauma and was admitted 3 days later to a university hospital ICU for right heart luxation due to right pericardial tear. Mechanical ventilation delayed radiological findings. Surgery by repositioning the heart and repairing the pericardial tear allowed restoration of hemodynamic equilibrium.
Journal of Pharmaceutical and Biomedical Analysis, Aug 1, 2022
COVID-19 infection evokes various systemic alterations that push patients not only towards severe... more COVID-19 infection evokes various systemic alterations that push patients not only towards severe acute respiratory syndrome but causes an important metabolic dysregulation with following multi-organ alteration and potentially poor outcome. To discover novel potential biomarkers able to predict disease’s severity and patient’s outcome, in this study we applied untargeted lipidomics, by a reversed phase ultra-high performance liquid chromatography-trapped ion mobility mass spectrometry platform (RP-UHPLC-TIMS-MS), on blood samples collected at hospital admission in an Italian cohort of COVID-19 patients (45 mild, 54 severe, 21 controls). In a subset of patients, we also collected a second blood sample in correspondence of clinical phenotype modification (longitudinal population). Plasma lipid profiles revealed several lipids significantly modified in COVID-19 patients with respect to controls and able to discern between mild and severe clinical phenotype. Severe patients were characterized by a progressive decrease in the levels of LPCs, LPC-Os, PC-Os, and, on the contrary, an increase in overall TGs, PEs, and Ceramides. A machine learning model was built by using both the entire dataset and with a restricted lipid panel dataset, delivering comparable results in predicting severity (AUC= 0.777, CI: 0.639–0.904) and outcome (AUC= 0.789, CI: 0.658–0.910). Finally, re-building the model with 25 longitudinal (t1) samples, this resulted in 21 patients correctly classified. In conclusion, this study highlights specific lipid profiles that could be used monitor the possible trajectory of COVID-19 patients at hospital admission, which could be used in targeted approaches.
Introduction: Levosimendan is a positive inotropic molecule that does not reduce splanchnic circu... more Introduction: Levosimendan is a positive inotropic molecule that does not reduce splanchnic circulation and has anti ischemic properties by opening mito KATP channels. Cirrhosis is a chronic and diffuse process characterized by fibrosis and the conversion of typical liver architecture into structurally abnormal nodules. In the late stages of the disease, cirrhosis is responsible for organ failure and complications such as cirrhotic cardiomyopathy and hepatic encephalopathy. Material and methods: We examined the effect of levosimendan in rat models of liver cirrhosis. Male Wistar rats were divided into four groups: Group A: cirrhotic rats 14 days after bile duct ligation (BDL); Group B: control (intact rats); Group A1: BDL and levosimendan (liver cirrhosis induced by bile duct ligation plus intraperitoneal administration of levosimendan); Group B1: control and levosimendan (intact animals with normal liver function treated with an intraperitoneal injection of levosimendan). Each grou...
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